Scars Flashcards
(18 cards)
T/F Some patients may be reluctant or unable to provide a detailed history of their scars or articulate their goals for treatment
*True
Scars & their stories must be respected. Some scars result in feelings of pride but others may hold complex history of trauma & emotional pain. Some patients may be reluctant or unable to provide detailed history of their scars or articulate their goals for treatment.
What are the 4 Phases of Healing?
- Hemostasis Phase
• BVs constrict to restrict blood flow
• Platelets stick together to seal the break - Inflammatory Phase
• Blood clotting begins, lasts few days after injury/ surgery, wound is red & inflamed - Proliferation Phase
•New tissue (collagen fibers) form to close the wound, area will feel raised & scabbed
•Lasts 2-10 days - Remodelling Phase
•Phase where scar forms
•As scar tissue forms, nerves heal, feeling returns to
area & scar feels less proliferated
What is a scar?
- Fibrous tissue that replaces normal tissues
- Body’s natural way of healing & replacing lost or damaged skin
- Scars may be formed for many different reasons, including result of infections, surgery, injuries, or inflammation of tissue
- Scars may appear anywhere on body, composition of scar may vary
- Scar may appear flat, lumpy, sunken, or coloured, may be painful or itchy
- Final look of scar depends on many factors, including skin type, location on body, direction of wound, type of injury, age of person with scar, & their nutritional status
What are the Different Types of Scars?
• Normotrophic Scars
• Adhesions
• Contracture Scars
• Keloid Scars
• Hypertrophic Scars
What are Normotrophic Scars?
• Scars not elevated above skin level
• Majority form as result of adequate reaction of body to injury. If wound passes all stages of cicatrization without deviations, normotrophic scar is formed
What are Adhesions?
• Result from replacement of normal tissue with connective tissue after burn, wound, surgery, radiation, or disease destroys original tissues. Characterized by loss of mobility of tissues that normally move or glide in relation to each other. Contribute to impaired muscle, joint & connective tissue integrity.
What are Contracture Scars?
• Abnormal occurrence when large area of skin is damaged & lost, resulting in scar. Scar formation pulls edges of skin together, causing tight area of skin. Decrease in size of skin can then affect muscles, joints, & tendons, causing decrease in movement.
What are Keloid Scars?
• Thick, rounded, irregular clusters of scar tissue. Grow at site of wound on skin, but beyond edges of borders of wound. Often appear red or darker in colour, compared to surrounding normal skin. Keloids are formed from collagen that body produces after wound has healed.
• May appear anywhere on body. More common on chest, back, shoulders, & earlobes.
What are Hypertrophic Scars?
• Similar to keloid scars
• Growth is confined within boundaries of original skin defect & may be more responsive to treatment. Scars may also look red, and are usually thick and raised.
When is it okay to treat a scar?
• When incision is healed & has become a scar
• Safe typically 2 weeks post-surgery/injury
• Managing scar tissue is most effective in first 2 years while scar is still forming & healing
• If you massage scar too early you could cause it to reopen or tear, leading to infection
What are Benefits of Scar Massage?
• Decrease scar tissue build-up. Excess scar tissue can make muscles stiff & weaker, in some cases can require scar tissue removal surgery
• Helps improve blood flow, which promotes healing & scar’s pliability
• Drains excess fluid to reduce swelling & proliferation
• Helps regain sensation in area & decrease numbness, tingling, soreness
• Increases ROM & scar’s flexibility. This makes movements feel less restrictive & “tight”
• May help with appearance of scar
What are Indications of Scar Treatment?
• Incisions from surgery/scar tissue from injury in CHRONIC STAGE OG TISSUE HEALING
• Tethering: may help loosen scars that may be attached to underlying or surrounding tissue
• Pain & hypersensitivity: may help desensitize
• Tightness: may help soften & increase pliability of scar
• Bulk: may help flatten bulky scars (with exception to keloids)
What are Contraindications of Scar Treatment?
• Open wound (< 2 weeks post-surgery/injury)
• Area is in proliferation phase, still healing
• Follow all Massage Therapy CI’s (ex. fever, uncontrolled hypertension, etc.)
What are Precautions of Scar Treatment?
• Keloids: scar tissue continues to form long after wound heals. Massaging keloid may irritate it, stimulate scar & can continue to grow. Massage 12cm around keloid. Other therapies such as laser therapy, corticosteroid shots, cryotherapy, etc. may be more suitable.
• Pain & hypersensitivity: work within your patient’s tolerance
What are Modalities of Scar Treatment?
• Hydrotherapy:
• Paraffin Wax
• Hydrocollator
• Alternating Hot Towels
• Contrast Towels
• Castor Oil Compress
** Castor oil can be applied directly to treatment area & covered by saran wrap, towel & heat source.
** Paraffin wax may be used with castor oil when treating significant adhesions in an area.
What are Techniques of Scar Treatment?
• Fascial work (Direct & Indirect)
• Skin Rolling
• Frictions
• GST
How much pressure to apply?
• You should apply as much pressure as your patient can tolerate.
• Can implement 1-10 pain scale with patient.
• Begin with light pressure & progress to deeper & firmer pressure.
• Applying enough pressure to make scar area lighten in color or turn white.
What are Important things to Document for Scars?
• Location
• Type of scar
• Size/length
• Visual inspection or scar & skin: colour? Jagged? Tissue alignment?
• Mobility: does it move freely? What directions are restricted? Any adhesions felt under or around scar in surrounding tissues?
• Sensation mapping: numb? tingles? pain?
• ADLs affected?
• Previous scar work? What worked, what didn’t?
